Gastrointestinal Haemorrhage & Mesenteric Embolisation in Cyprus
Gastrointestinal haemorrhage is bleeding that occurs from the digestive tract. Bleeding from the oesophagus, stomach and small intestine is described as upper gastrointestinal haemorrhage and bleeding from the large bowel is described as lower gastrointestinal haemorrhage.
Gastrointestinal haemorrhage embolisation is a procedure in which Dr Zertalis uses ultrasound and X-rays (fluoroscopy) to navigate a fine tube (catheter) into the blood vessels supplying an abnormal bleeding area within your abdomen. This is followed by injection of small metal clips (embolisation coils) or fluid containing very small spheres (embolic particles) in order to block the bleeding arteries and control haemorrhage.
Regardless of the cause, bleeding from the upper GI tract can present as haematemesis (vomiting blood) or melaena (dark, tarry stools) whereas lower gastrointestinal haemorrhage presents as bright red blood from the rectum. Gastrointestinal haemorrhage can be a frightening and potentially life-threatening event particularly when there is large volume and fast rate of blood loss. Embolisation aims to identify, control haemorrhage and preserve life.
Gastrointestinal haemorrhage embolisation is a safe, effective and accurate procedure, but as
with any medical procedure there are some risks and complications that you may uncommonly experience.
Pain: Some patients experience pain after the procedure. This can vary from mild to moderate and can be managed with painkillers (analgesia).
Bleeding: Risk of bleeding that is significant is rare. Uncommonly you may get a small bruise at the needle entry point in the groin.
Infection: This is an uncommon complication. You will be given antibiotics before the procedure and you will be monitored during and after the procedure to check for signs of infection.
Non-target embolisation: In some patients, the anatomy of the mesenteric arteries may allow flow
of small metal springs (coils) or embolisation particles to a normal area of the gastrointestinal tract increasing the risk of bowel injury, ischaemia and perforation. Nonetheless, this significant complication is uncommon. Dr Zertalis will discuss this with you in detail.
Allergy to contrast (X-ray dye): Most adverse events are mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (< 0.005%).
Kidney Impairment: Impairment of kidney function can occur following the treatment due to the contrast agent or dehydration. You will have a drip placed before the procedure. This is to give you sufficient fluids to minimise the risk of problems with kidney function.
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (< 0.001%).
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and remember that even at this stage, you can still decide not to go ahead with procedure if you choose to do so.
Before the procedure
The procedure is performed under local anaesthetic and sedation if required. Relevant bloods test will be undertaken before the procedure and if your blood clotting is abnormal, blood transfusion may be necessary to correct this. If you have any concerns about having a blood transfusion, you should discuss these with Dr Zertalis. A short and thin plastic tube (cannula) will be placed into a vein in your arm.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the x-ray dye (contrast).
You will be asked to change into a hospital gown and lie on the X-ray table flat on your back. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. You will be given a sedative to relieve anxiety. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves. The skin near the point of insertion at the top of the leg (usually the right groin) will be cleaned with antiseptic and you will be covered with sterile drapes.
Dr Zertalis will use ultrasound to inject local anaesthetic in your groin and place a fine plastic tube (vascular sheath) into the artery (common femoral artery). Dr Zertalis will use X-ray equipment to navigate and guide another fine plastic tube (catheter) through the sheath into the arteries, which supply the abnormal area in your gastrointestinal tract.
X-ray dye (contrast) will be injected through the catheter to define the anatomy of the blood vessels and identify the source of haemorrhage. This is called an angiogram and you may experience a warm feeling in the abdomen – this is normal. The arteries supplying the abnormal bleeding area in your gastrointestinal tract are blocked by injecting small spheres suspended in liquid (particles) or small metal clips (embolisation coils).
At the end of the procedure the catheter and vascular sheath are removed and pressure is applied to the groin for 10-15 minutes to prevent bleeding. Every patient is different, however, expect to be in the radiology department up to 1 hour.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the groin will be checked by our team at regular intervals. You should expect to be in bed for 6 hours and to stay in hospital until you have fully recovered.